Lambs for the slaughter?

By | Published: April 12, 2011

I wish to examine the curious case of the possible resignation of Mr Norman Lamb. Many people will not have known until the last couple of days the importance of Mr Lamb. He is a trusted adviser to the Deputy Prime Minister. He is a Lib Dem NHS expert, who has said that the NHS policies need changing.

Mr Lamb we are told has been in continuous discussion with Mr Clegg about the NHS and the government’s proposed reforms since May 2010. In that case, Mr Lamb must have been actively involved in Mr Clegg’s participation in drafting the crucial July 2010 White Paper setting out the need for and nature of the very wide ranging NHS reforms.

Mr Clegg was one of three signatories of the Preface on the title page of the White Paper, “Equity and Excellence: Liberating the NHS”, with Mr Cameron and Mr Lansley. The one page Preface said the following:

“We will make the NHS more accountable to patients. We will free staff from excessive top down control…

“We will empower health professionals. Doctors and nurses must be able to use their professional judgement about what is right for patients. We will suppport this by giving front line staff more control.

“Of course our massive deficit and growing debt mean there are some difficult decisions to make. The NHS is not immune from these challenges. But far from being reason to abandon reform, it demands that we accelerate it…”

This seems to be crystal clear. Mr Clegg with the help of Mr Lamb signed up to a radical programme of health reform. There were no ifs and buts, no minority report, not even some precautionary spin against the details. Inside the document they co-authored it said all PCTs would be abolished, “Money will follow the patient”, “providers will be paid according to their performance”. The document pledged £20 billion of efficiency savings, and a reduction in NHS management costs by a dramatic 45% in four years. “We will radically delayer and simplify the number of NHS bodies”. The NHS providers of health care were to be converted into social enterprises, freed to compete. The private sector was also to be invited to compete to provide better health care. There were to be maximum prices, but no restriction on price competition beyond that. Monitor was to have a duty to promote competition, to ensure better quality and value for money for the NHS. The approach of providing good quality care free at the point of use was preserved but much else was to change to deliver it in a patient friendly way.

Many people now say they did not understand the nature of the NHS reforms, or how wide ranging they were. Many claim not to have read the Conservative Manifesto which had in it the main outlines, or the Lib Dem one which also covered some of this ground. It is strange however that those most concerned about the NHS today claim they were in ignorance of the scope of the changes. Why did they not bother to read the seminal consultation document, this White Paper, issued ten months ago? Surely when this was launched with considerable publicity it was the time to catch up and make an effort to understand the plan. Why didn’t they have the row then before the legislation passed the Commons easily? Where were they when the Bill made swift passage?

Mr Lamb must have read the White Paper and given his views before and afterwards. Mr Clegg was presumably broadly happy with the document, and in his interview yesterday still seems to be happy with the main themes within it.

Mr Lamb needs to be careful. He is in danger of being used by the enemies of the government and the enemies of Health reform at a sensitive time for the government he supports. If he makes Mr Clegg flip flop on his robust support for the White Paper he weakens his party as well as the government. It just leads people to ask why did Lib Dems sign up for these reforms in 2010, only to seek to overturn them in 2011 at the first sign of concerted Labour and Union opposition? May-July 2010 was the time to show political caution, the time to cause trouble on these proposals. For a signatory to the White Paper 2011 is the time to show some steel and determination to put through the vision they signed up to ten months ago.

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Looking at the slightly wider picture, why is it that pretty much every Western government is running a statist, big government, fiat currency, deficit-financed project which is giving us high-inflation, high unemployment and clunky failing, unresponsive “public services” and endless red-tape.

“I think they may be right in embarking on it [the austerity programme] but I think they will probably have the sense that they will have to modify it when the effects are felt,” Soros said. “I don’t think it can possibly be implemented without pushing the economy into a recession.” Noting that the initial market reaction to the government’s tough stance had been positive, Soros added: “We will have to see it unfold. My expectation is that it will prove to be unsustainable.”

Couldn’t have put it better myself – the model is broken – and the replacement model of hard work, responsibility, transparency and accountability doesnt appear very attractive to any of the politicial parties because the public (i.e. focus groups) don’t like it.

This is the biggest risk – it needs to be done faster. If the Lib Dems force an election then Labour will win NOT because they deserve to (which WOULD be fair) but because the boundaries are fixed in their favour.

We cannot have our freedoms and sovereignity decided by corrupt boundaries. This must be an urgent task.

With the best will in the world the Boundary Commissions have a difficult task adjusting boundaries to keep up with rapid population movements; the population data they have available quickly become out of date, and not all of the adult population are citizens and eligible to vote.

But in any case if you look at the results of the last general election:

the average number of Tory votes per Tory MP works out at 34,940, while the average number of Labour votes per Labour MP works out at 33,370, and it would only have needed the Tories to have won 6 more seats and Labour to have won 6 fewer to correct that disparity.

That would have given the Tories 313 seats rather than 307, still short of an overall majority.

The Boundary Commission needs a boot up the arse. They operate 10 years out of date. That is far too long in the modern world in addition to which I suspect they don’t have” the best will in the world”

Cameron needs to kick this into action though. Come to think of it he has probably deliberately kicked it into the long grass in an effort to prolong the corrupt old LibLabCon world he loves so much.

So given that Cameron got more votes than Blair in 2005, and Brown got less than Major in 1997, with the tories beating labour by 7 % points and yet Cameron still only got 49 more seats than labour? Yet from a smaller share of the vote in 2005, (and only beating the tories by 3% points labour had 158 more seats than the tories.

the bias could be in the opposite direction after the boundaries have been revised:

“There has been some suggestion that the equalisation of constituency size will give the Tories about 8 to 12 extra MPs. That number is certainly not to be sneezed at but CCHQ is convinced that, if the boundaries fall where they expect them to fall, the gain is likely to be up to twenty extra Conservative MPs. Labour understand this and that is why they fought so hard against the Bill in the House of Lords.”

On their respectives shares of the votes at the last election, the Tories are short of about 6 seats vis a vis Labour; transfer not just those 6 but 20, and there would be a new bias in favour of the Tories of about 14 seats.

Which pro-Tory bias vis a vis Labour could be either counteracted or reinforced if AV is adopted, depending on whether you look at the effects it might have had at the last election or at the effects it might have at the next election on current poll ratings:

The Tories got 47% of the seats on 36% of the votes. Yes the system is biased, but biased in their favour, not against them.

If they really wanted fairness, they’d support proportional representation. They hate this idea, because it would prevent the Conservative Party (and the Labour party, for that matter) from thwarting the will of the British people.

So it’s conceivable that in 9 months time things could be falling apart and we could be stuck with AV, although hopefully not, and the old boundaries.

Or we could try and limp along for another 3 and a half years doing everything possible to try and placate the Lib Dem left which will do the Conservatives no favours with their disgruntled grass roots.

I know that politics is the art of the possible but it’s hardly what I’d call playing a blinder, more a case of blundering along.

“If there is a “yes” vote in the referendum (that is, more people vote yes than vote no) then the alternative vote provisions must be brought into force on the same day as the coming into force of an Order in Council giving effect to the Boundary Commissions’ recommendations for altering the parliamentary constituencies made under the revised scheme in Part 2 of the Act.”

Now I don’t know now whether we should hope for a ‘yes’ vote or a ‘no’ vote!

If we vote ‘yes’ we are guaranteed the boundary changes (although we could be in a deliciously farcical situation where we approve AV then have an election under FPTP in a years time as the boundary changes aren’t ready!) but if we vote ‘no’ we could be in a situation where the Lib Dems mutiny and the incoming Labour government abandons the boundary changes.

Looks like the only game in town for the Conservatives is appeasement of the Lib Dem left until 2015 – ouch!

Indeed show some back bone, do the right thing and reform the NHS. Better still start charging for it for all so that the money follows the patient automatically. Then the patient customer might be treated as a customer rather than just a nuisance who has to be very patient and take what they are given.

Also make sure the NHS buyers use their massive buying power to get a good deal on drugs and materials, they do not are the moment, and stop all alternative medicine in the NHS and nearly all vanity and similar surgery.

I am quite sure that Oxford and Cambridge do indeed look for potential in interviews and makes allowances for the fact applicant’s schools are not all equally good and are wisely discriminating but do not discriminate on race. Perhaps 3 A from a “bog standard” comp is sometimes a better prospect than 3A*s from Eton. But does Cameron really expect them to judge potential for say, a history degree, on their (performance at non academic pursuits-ed)

Rather more worrying is that so many come out with good degrees like Balls, Brown, Blair, Cameron and Clegg and yet can still be so misguided (or deluded) as not to understand such basic concepts such as the separation of cause and effect, running an economy, risk and reward, regression to the mean, bus and train real world efficiencies, the madness of most green technology & energy economics and the huge uncertainty in global warming projections.

Also that excessive transfers of wealth from the responsible to the feckless and an over large state is not good economic sense and benefits no one in the end.

I think there’s a wider issues here. Remember Mr Clegg’s whisper to Mr Cameron “There’s nothing left to disagree about….”? It seems the LibDem leadership are fully behind the Conservatives in most areas of policy. Its possible that either Norman Lamb is making a public stand to fake their differences, i.e. to try to maintain the LibDem brand identity and appeal to the grass root support. It seems more likely however that the LibDems have been split into two and Mr Lamb (among others) are now showing which side they belong to.

The Lib Dems have, by being out of any sort of power for 60 or more years, forgotten that lesson. They have been all talk for decades, much of which has been unrealistic, so it did not matter what they promised before, as it was unlikely they would ever have to deliver on any promises made.

Now they find themselves with some power, and having to make good some of the promises made, some will have second thoughts and feel uncomfortable about being unpopular for a while.

All for the National good sounds great, until you have to make some hard decisions, they are now starting to come thick and fast. Time for those without the courage to act on policies made, to get out of the way, for the common good.

If Lamb wants to do a David Davies then let him, should be Clegg’s response. The LibDems have to put up with the rough and the smoothe and the next 18 months is not the time to be rocking the boat. The time for cherrypicking is over and they’ll just have to get on with it. If Lamb feels he can’t go along with this then arrivederci!
The sooner the coalition gets on with all of the bad news the better but their communication skills leave an awful lot to be desired!

“The Lib Dems may well get their AV, but when they get it, the irony will be that no one will vote for them”

You may well be right here. AV makes it easier for voters to get rid of unpopular sitting MPs, because they don’t have to previously synchronise on an alternative candidate to support. So AV could well be what loses Clegg his seat.

Lamb is typical of the Lib Dems. What he can’t take is unpopularity – along with the likes of Simon Hughes he would be much happier sitting on the sidelines making the occasional righteous & hand-wringing criticism of a tough policy.

It is essential that the Government ignores the likes of Mr Lamb and proceeds with these reforms, as they must with the reforms in education and welfare. We have only got one shot to fix the massive damage of 13 years of Labour and decades of left-driven centralisation and distortion of public services, which the Thatcher / Major governments didn’t deal with. If the Government sticks to its guns on these reforms, the public will see the benefits and reward that courage at the next election.

You should get out and read the papers more. Clegg is quoted in one of the broadsheets this morning as supporting Lamb’s intervention. Political necessity … almost certainly. But he’s obviously decided that he’s not going to put his neck out on this one, as he did on tuition fees. And I can’t help feeling that if the Conservative party spelt out its intentions on the NHS, as you have done here, then we would probably have a Lib-Lab coalition and your seat would become a marginal.

At least 50% of LibDems do not support Mr Clegg’s leadership; they shy away from power in the way that wild beasts shy away from fire. Pity poor Mr Clegg who knows that the country is ungovernable without the coalition but watches his Party’s poll rating decline.

We may have to introduce the abolition of PCTs as a Pilot Study in the first instance. The reform should be successful and any teething troubles can be overcome during the Pilot Study. That will, however, reduce bureaucratic cost savings in the first year, so there will have to be additional public expenditure reductions elsewhere. Do remind the PM and DPM of this. Do remind them publicly.

Norman Lamb is the son of Hubert Lamb the scientist who founded the CRU, later taken over as a well funded site of global warming alarmism and scientific fraud. Lamb senior was a very fine scientist, who came up with the definitive figures for the Medieval Warm Period (about 1 .5 C warmer than now) and never accepted the catastrophic warming scam.

His LibDem son must know catastrophic warming is largely or entirely fraudulent but you cannot say so in his party. This may affect opinions on whether his threat to resign over NHS reforms is principled or tactical.

The resignation threat (is this a threat??) by Mr Lamb should be accepted gratefully by Mr Clegg. If the man does not have the courage of his earlier conviction, he must go. If he has had a genuine change of heart, (ie not the result of some hidden external pressure), he must go. If he has caved in to an outside influence, he should be sacked and his card marked for the future as being possibly unreliable under pressure
It is time, surely, for these late arrivals to power to accept the need for definite action to clear up the mess left by the last lot.

I still think that this country would have been better placed having a minority Tory government rather than having to deal with the LibDem flip flops in a coalition administration.

In a matter of a few weeks we will be having the AV referendum. Whichever way the vote goes the damage to the coalition will be immense thereby really hurting the chances of fixing this country (including the NHS). The vision and steel displayed last year by the coalition partners will further evaporate.

This is the same idea that was used to privatise British Rail. Each GP group will become a privatisable chunk. In time MediPlan will buy you better treatment. Just like Dentisty. You can still get NHS dentists but most people take insurance, DenPlan. This is the future of the NHS. All of the redundant staff from the PCTs will be taken up by the GP groups. In effect you will get lots of little PCTs. However the end result will be privatised. In a few years time it will be run by the EU anyway.

Too many people are misled by the Lib-Dem label, they believe neither in liberalism nor democracy. They tell any audience what they think that particular audience wants, and then move onto the next group and say the opposite. It comes naturally to them, we see it all the time in their fiefdoms here. Not to be trusted, any of them.

Personally, I think the Lamb issue is more of a personal issue than political: Lamb broadly agrees with the policy, but wants it implemented a bit slower, and a bit more cautiously. These issues would normally be settled in private, but according to the rumour mill, Mr Lansley and Lamb don’t get on.

I think Mr Lansley is right. If it is best done, it is best done quickly.

For what it is worth, I don’t personally agree with these proposals, I think it is chewing off more than we can tackle. As a government, the Conservative / Lib Dems do not seem to have learned lessons from Thatcher. It is important not to tackle too many enemies at once.

We are trying to do too many things, and I fear that we will end up not getting enough successes to get the second term.

I am in regular touch with a Libdem supporter. It is fascinating. Muddle. Definitely. But every time the government does or says anything at all, she is straight in with a vicious (and often ill considered) attack.
How typical she is, I have no means of knowing.

This looks like an argument lost before it began. If the government cannot line up support for its proposals, it ought to think again. If it can, then it should wage a propaganda war on its opponents with the emphasis on the word war.

A lot of Liberals, for example that man in Liverpool, fear losing their status and attached perks in May, and that is more important to them than really saving the NHS.

The government has no transmitters, cameras, microphones or studios nor printing presses.

It is reliant on the goodwill of the media. If we had a balanced media, either through regulation, diversity or a mixture of the both then the government’s original message may well have the chance of being heard.

However, it has to contend with what we have got and the message either does not get through, or is distorted or is reported from the opposite point of view.

Unless we have a level playing field in the media, the government – and less so the Conservative Party and even less so backbench Conservative MPs – have little chance of having their say.

I have serious criticisms of the way some members of the government have been on the defensive since the election. However I believe we are in a chicken and egg situation where the left wing media attack and ministers defend. Ministers are now starting to defend even before the attack comes.

With an ex eu quango commissioner as BBC Trust Chairman it doesn’t seems as if things will improve any time soon.

The NHS will not change until the user is able to BUY the service he/she needs from the supplier. This is as is the case with the private hospitals. However, this approach will have to be adapted to the universal service the NHS provides.
Just one example. Cataract replacement with plastic lens. The NHS is free(?) but only one type of lens is on offer. If one needs say a dual focus lens one has to go to a private set up where one pays the total cost (£2000+ per eye) whereas the better lens costs just £400 extra.

This is beginning to come into focus. It is hospital staff that object to the proposals because the hospitals will lose their power. At the moment, hospital consultants look down on GPs and more or less insist on referrals. Under the new proposals, the GPs – who have frequent direct contact with the customers (or patients as they are known) – will control the budgets and evaluate the performance of the hospitals. Furthermore, GPs have a right to use new providers of health services.

Who are objecting the most? The BMA and the nurses union. Who does the BMA favour? Hospitals and consultants.

Keep up the good work, Mr Lansley. The NHS is a nasty Stalinist monopoly whose time has gone.

About John Redwood

John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.